Saturday, January 4, 2020

Four Days into 2020 - Getting My Ass Handed to Me By Call

When I wrote my post about resolutions for 2020, I was very intentional in talking about "experimenting".  I knew that I wasn't going to be able to change everything the moment the clock struck midnight (I am not a magician), so I wanted to give myself permission to do things gradually and to falter along the way.

Well. 

This was a good thing.

I went back to work on Thursday, and I am starting the year with four days on call.  And what a call it has been.  I've had multiple really sick people spread all over the province, and my pager has been going off seemingly constantly.  Whereas I thought I'd be staying late to keep up with paperwork, I've had to stay late just to get the bare minimum done.

It's honestly a little demoralizing.  I'm only three days into the work year, and I already have new letters that need to be dictated and old letters that need to be edited.  And I've had one night of insomnia, followed by a sleep deprivation-induced migraine.  (Awesome combo)

But...it's a process.  And I know that call is the hardest part of my job, particularly when it's busy call.  So I'm breathing.  And focusing on what I can learn from this experience, rather than on all the things that don't seem to be working.

When I reflect on the past few days, the biggest thing that I'm reminded of is how much I dislike the uncertainty of call.  This isn't really shocking, as I'm a person who hates surprises and likes to have everything planned.  Carrying around a tiny piece of plastic that can scream at me and derail my day without warning is really not my favourite thing.

Fortunately, there are things that I can do to make this easier to cope with.  The biggest one, and one that I've been leaning towards but not quite willing to commit to until now, is not making plans with other people while I'm on call.  In theory, the best thing about home call is the fact that I can continue to live a normal life while I'm call, but in reality, everything is made worse by the pager hanging over me.  I hate planning to meet someone and then having to cancel (or getting called away in the middle of doing something).  It happened on Thursday night when I was planning to meet a BFF for my favourite yoga class, and then it happened again on Friday night when I was supposed to go to a party for people from my residency.  And it sucked.

Not to say that I will never make plans (I would still try to make it to the Friday night party, for example, as the date was fixed), but that I'm going to try to keep my call days as flexible as possible.  Some of this is more mental than anything - trying to not get attached to any idea of how the day will look, but rather take things as they come*.  If the day is busy and I have to work until late, I'm mentally prepared for that.  If it's not and I have time for non-work things, then it's a bonus and I can use the opportunity to go to yoga or wash dishes or sit on the couch with the cats playing Stone Age online with The 76K Project.  (Mostly the latter).

I'm trying to approach my current weekend this way, and so far it seems to be helping (?).  When I got up this morning, instead of trying to map out the weekend, I made myself a list of things from highest to lowest priority.  Providing good patient care was #1, with prepping for my upcoming lectures (which I technically should've had done by yesterday) #2.  While I was responding to pages this morning, I spent a few hours getting the lectures done, thus getting the most important (as well as the most stress-inducing) task out of the way.  And then the pager was kind to me, and I was able to go to an hour of the worst suffering I would ever willingly subject myself to yoga.  I've also managed to get a few other important items knocked off my to-do list, and if I ever stop playing online games I will even do my dishes.

The change in approach and mindset has already made me a little less emotionally reactive when the pager has gone off.  It has still been annoying, and I'm not looking forward to starting my day at the hospital tomorrow, but it's better.  Will it help in the long term?  I guess I'll see...

*I feel like call gives me some sense of what it would be like to be a parent.  Everything is going well, then *BAM*, one kid spills a 2 L of milk on the floor and the other is running around naked drawing on themself with permanent marker.

Wednesday, January 1, 2020

2020 - Progress, Not Perfection

It has been a few years since I made a New Year's resolution.  In 2017, I resolved to say no to more things, which obviously wasn't enough given the burnout I hit in 2019.  In 2018, I seem to have been in a bit of a dark place in which I thought resolving to do anything was futile, because I wouldn't be able to stick to it anyway.

The past two years have shown me that, under the right circumstances, I can actually make pretty big changes in my life.  In that time, I've greatly expanded and strengthened my social circle, to the point where I couldn't see everyone I wanted to during my two weeks of holidays.  I've started a (somewhat) daily meditation practice and gone to a meditation retreat.  I've been really consistent with yoga, going to 45 classes in the first half of the year and 83 in the second half*.  I've adopted an intuitive eating practice, which has led me to a much healthier relationship with food (and overall healthier eating habits) than I've had in my life.  And I've cut back on my work responsibilities to the point where I am only slightly dreading returning to it tomorrow.

When I look back at the changes I've made, the keys for me have been twofold:  motivation and gradual progress.  I haven't made changes out of a sense that it's what I should do, but rather because I can see how the changes will make me happier and otherwise enhance my life.  The goals I set for myself are personal and are aligned with my values, not things that other people think are important.  I've also started slowly with things (It took me over a decade to develop a regular yoga practice!) and allowed myself to learn from the process of change, rather than thinking that I'll be perfect at a new thing the moment I start it.  As Done By 40 said in a comment on my last post, "Progress, not perfection".

Looking ahead to 2020, my hope is to have a relatively uneventful year.  2019 was a year of tremendous growth and change, but it was also a hard one.  I kind of want to catch my breath**.  I want to continue with my mindfulness practice, and I'm aiming for a regular practice of four yoga classes per week and meditating every day.  I want to keep building on the friendships I have.  My financial situation is really good (No debt!  Lots of investments!), and I mostly just want to keep working and hoarding money for the future.  Overall, I don't anticipate any radical changes in 2020***.

But....in 2020, I would like to work on keeping up with everything.  I feel like I'm perpetually behind - on housework, on work work - and I find it draining.  I hate having clutter in my home and 100 dictations to sign off on in my inbox.  I hate feeling like I'm perpetually catching up, only to have new work pile on top of me the moment I finally get through the old work.  And it's not like I'm saving time by procrastinating on things - I have the same amount of work to do, regardless of whether I do it right away or put it off for weeks.

Which...is really everyone's problem, right?  While the specific tasks may differ, I think we all have an endless to-do list that is never done to our satisfaction.  So, while I'm setting this as a goal, I am also trying to be realistic.  And to extend a lot of grace and compassion to myself.  Because no matter how hard I work, I am never going to get to the bottom of the list.  And I need to make peace with that.

As far as how to do this...I'm going to experiment.  Try something for a while, see how it goes, then keep it or reject it.  I'm not expecting that I will get to the end of the list by midnight tonight and then always keep up with it, forever and ever.  I know it will be a process, and so I'm trying to give myself the time and space (and lots of grace!) to work with the process.  For the moment, I am going to try three things that I think may help:

1)  Going to later yoga classes:  Some of my favourite yoga classes are at 5:30 PM, which unfortunately means leaving work at 4:30 and therefore losing out on a lot of potential work time.  I'm going to try sticking to a regular weekly schedule, with a 7 PM class as my earliest, so that I get an extra hour or so at work at the end of many days.

2)  Coming to work earlier:  My work days start between 8 and 9:30 am (sometimes 10 if I really let myself sleep in) depending on whether or not I have a morning clinic.  I'm going to try to get to work for 8 am consistently so that I'm getting some extra work time first thing in the morning.  As an added bonus, I'm hopeful that the more regular wake up/go to work schedule will be good for my insomnia.

I recognize that I'm proposing to both start later and finish later, which has the potential to simply be too much work.  But I'm hoping that this will allow me to get most, if not all, of my work done during the week, thus giving me weekends completely off to recharge.  I'll see how it goes...

3)  Just doing the shit now:  I'm human.  I procrastinate.  Sometimes epically.  Yesterday I logged onto a conference website, thinking it was the last day for early bird registration, and when I discovered that I still had two weeks, I logged off.  I did very quickly log back on and register for the conference (also booked my Airbnb like a superstar), but my initial impulse was to procrastinate for another two weeks.  I've already started trying to break myself of this habit, as I know it is a huge contributor to the piles of things to do that build up.  So I'm trying to just respond to the email, just put my dishes in the dishwasher, just put away the laundry that I've already folded (instead of it sitting on my dresser until the basket is empty), and just add the item to my grocery list (instead of cursing myself when I get home from the store without it).  Just.  Do.  The.  Shit.

Who knows if this will work.  I like some of the 5:30 yoga classes, so I might cave and go to them.  My bed is very comfortable, so I may sleep in.  Doing the shit gets tedious.  But I'm going to give it a try and see where it takes me.

Any suggestions as I try to get more on top of things in my life?

*At least.  I only track yoga classes for my main studio; I think I did another 10 or so at other studios over the year.

**I feel like I'm tempting the universe by typing this.

***Seriously, I feel like I'm baiting the universe with this post.

Friday, December 27, 2019

2019 - The Year of Breaking Open

I'm not big into dates, but for some reason I love the start of the new year.  Even though there's nothing magical about the transition from December 31 to January 1, it always gets me reflecting on the previous year and thinking ahead to the next.  When I re-read my New Year's post from this year, I had to laugh at my intention for 2019:

"And what for 2019?  Mostly, I want to keep going on the path that I'm already on.  I want to remain in the present moment, enjoying it when I can and learning from it when I can't."

Learning from it when I can't describes so much of the past year.  I existed in a state of near-constant stress for months, and then I basically fell apart when the chronic stress became too much.  For weeks, I wasn't certain if I would choose to (or even be able to) stay at work.  It was horrible.

Probably the wisest thing I did, and something that was only possible because of my mindfulness practice, was stay present in the tough moments.  My mantra through that time, which I would sometimes recite multiple times in a day, was "Be patient.  Be present."  I somehow knew that, if I could just show up for those moments, that I would learn something important from them.

And I have learned an incredible amount over the past year.  I've learned that I am limited in how much I can do well (as is everyone), and more importantly, I've learned that I have the support of my institution to set limits on my work.  I don't have to overbook all of my clinics.  I don't have to work through weekends most of the time.  I don't have to say yes to every administrative task that comes my way.  I can (and absolutely must) say no.

I've also learned that I am very hard working, even though I don't always feel that way when I compare myself to the overachievers who seem to be everywhere in medicine.  I regularly go beyond what I need to for my patients, and I show up for them even on the days when I would rather pull the covers over my head.  I'm committed to the work that I do, and I put in the effort needed to be a really good doctor.

Overall, as hard as a lot of the past year has been, I'm really proud of myself for getting through it.  And for not quitting my job!  Because it's generally a pretty good one, and I do a pretty good job at it, if I may say so myself.

Saturday, December 14, 2019

How I Almost Moved Into a House But Didn't

A few weeks ago, I opened up Facebook while eating breakfast and saw an ad for the perfect house.  Only a few minutes from where I currently live and still in a neighbourhood that I love, the house was the ideal balance between "old enough to be charming" and "new enough to not have knob and tube wiring*".  And it was for rent, which is probably the only way I'm ever going to get into a house, as I'm utterly terrified of buying something.

It took me only a few minutes to email the person renting it, and I stopped by to see it on my way home from work that evening.  When I walked in, the house was toasty warm and beautifully decorated for Christmas, and my heart said a very loud yes.  This is my home.  I want to live here.

For the next four days, I lived and breathed that house.  I posted about it on Twitter and Facebook, I dreamed of all the things I could do in it (Butterfly garden!  Bat house!  Little Free Library!), and I started rescheduling my upcoming vacation to include packing up my apartment and moving into a house.  I was 100% mentally there.

And then...I went back.  I went to see it again with my Mom and to work out the practical details, and the reality of the house started to sink it.  Houses come with lawns to be mowed and driveways to be shoveled and windows (so many beautiful windows) to be washed.  And the $400 more per month in rent was only the beginning of the increased costs - I would have to add electricity and water and gas and a home alarm system and alllll the things I would want to buy with double the space that I currently have.  Yes, I could host games nights in a stylish historic living room warmed by a gas fireplace, but I would also have to get up early on snow days to dig my car out of the detached and unheated garage.

I went home that night, and I thought and thought and thought, trying to figure out what to do.  It wasn't a question of whether I could afford it - I save a high percentage of my income, so there is money in my budget to move into a much nicer home than where I'm living right now.  The question was, why did I want to move into a house?

The answer, for me, was social.  I wanted to host games nights for friends and have my aunt over for coffee and drop in informally on the friend who lives around the corner.  All really good things.  But...none of them dependent on being in a house.  Sure, my one-bedroom apartment is limited in its ability to host big gatherings, but I'm an introvert who actually doesn't really like being around large groups of people.  Two to six people is about ideal for me, and my dining room table can comfortably seat six.  The size of my apartment isn't really what limits me socially - it's time and energy, both of which I'd have less of in a house.

The financial side of it, even though I could afford it, was also a big issue.  The added costs would be approximately equal to one month a year of income - that's huge!  When I looked at it that way, and asked myself "Would I rather have that house or an extra month of vacation every year?", vacation won without a moment of hesitation**.

So....I still live in the apartment where I've lived for nine years.  And...I'm good with that.  Work is a 6-minute drive when there's no traffic (and under 30 in even the worst of rush hour traffic).  I can easily walk to fabulous restaurants and coffee shops.  And I have time and money and energy to do the thing that's most important to me:  connect.

*Technically renovated to not have knob and tube wiring...but still new enough to not be a nightmare of old home disasters.

**Not that I'm going to take an extra month of vacation, as my vacation time is already pretty ridiculously amazing, and I do need to earn money.

Friday, November 8, 2019

How to Rest

As a resident, I had almost no time off.  I worked as much as 100 hours in some weeks, often in 24-hour-plus stretches, so I was basically always either at work or collapsed half dead on my couch.  I didn't have to think about the concept of work-life balance, because there wasn't any.  I worked, and I did what I could to survive the five years relatively unscathed*.

And then it ended.  And I was an attending!  With a better schedule!  And money!  And completely no idea of how to take care of myself in a long-term, I want to be happy and not die of a heart attack kind of way.

I knew that having a life outside of work was a priority for me, but because it had been so long since I had had one, I had no idea how to make that happen.  I also faced the new challenge of always having work to do.  Labs to review, patients to call, prescriptions to renew, presentations to prepare - I live in a giant game of medical Whack-A-Mole.  For the longest time, I tried to get everything done before I would "allow" myself to rest, which meant that I was always trying to work and never actually resting.

Except....I was wasting a shit tonne of time.  Like most people, I have a limited amount of mental and physical energy every day (spoons!), and once I use it up, I can pretend to be working, but I'm really not.  I'm checking Twitter.  Or Instagram.  Or Facebook.  Or going to Starbucks for another tea.  It feels like work time, and I resent it, but I'm accomplishing very little.

Earlier this year, when work seemed to occupy every waking and sleeping moment of my life, I was finally forced to acknowledge that I can only accomplish a finite amount of things.  And this amount is never as much as I want it to be.  Yet I was working myself beyond a sustainable limit, and for what?  Desire for more money that I didn't need?  A sense of obligation?  Conditioning from the medical system to never rest?  I was failing miserably at having a good life for really no reason at all.

I am incredibly lucky to have flexibility in my job and to earn much more than I need to, which as I've mentioned over and over again has allowed me to back off from work and regain some much needed time.  But just as importantly, recognizing my limits has given me permission to rest.  To designate evenings and weekends and long stretches of holidays as "not working" time, rather than "working but not actually accomplishing anything because I keep Tweeting about marshmallow peanut butter squares" time.

Which makes all the difference.  Because distracting myself on the Internet while I'm supposed to be working isn't restful.  Sleep is.  Yoga is.  Meditation is**.

Not doing is restful.

Next week I'm on call again, and I have a long list of things I would like to get done before I go back on call.  Some of which I will get done tomorrow morning, but once my designated work time is over, I'm going to stop.  I'm going to go to the theatre with my mom, and then I'm going to eat and drink more than is doctor recommended.  On Sunday I'm taking myself to a Nordic spa, and I can guarantee that I will spend the whole day moving from heated bed to hot tub to wet sauna to dry.  Because I will need all my spoons next week, and trying to work all weekend is not going to give any of them back.

*By the end, I had raging anxiety, was socially isolated, and had lost all self-care habits.  "Unscathed" is defined very loosely here.

** When my f-ing monkey brain isn't wandering all over the place, which it always is, so I take this back, meditation is not restful, dammit.

Thursday, October 31, 2019

The Return of Happiness

Years ago, when I was early in residency training, I wrote a post on the first version of this blog called "Fundamentally Happy"*.  In it, I talked about how, despite the many challenges of residency, at my core I was happy.  Satisfied with where I was in life and with where I was going.

Earlier this year, I lost that feeling.  Not just for a moment, but for months on end.  I felt like I was working constantly and as if life was a perpetual slog through overbooked clinics and piles of paperwork.  In the beginning, I was having trouble staying caught up for more than the briefest of moments, and eventually I lost the ability to ever catch up.  I was slowly drowning.

It has taken a lot to come back.   I have drawn on every resource available to me to get through this, and I have been so lucky to have been met by nothing but support everywhere I went.  Support from friends, colleagues (remember the one who took three weeks of summer call for me?), and even my department head.  I am so thankful to have had a good experience, because I know that many physicians who burn out don't.

Life is different now.  My clinics are capped, so even on days when everyone shows up, I usually run (at least close to) on time.  I don't run over too often, and some days I finish early.  I still get behind on paperwork sometimes, but it's usually because I've taken something extra on (like travelling to a remote community to share my knowledge with a group of rural physicians) and not because the work load is too much.  And when I get behind, I can catch up again.

I can finally breathe again.  Not the shallow, panicked, desperate breaths that I was breathing for months.  Deep, calm, happy breaths.

Things are so much better.

*I think.  My memory is crappy.

Monday, September 2, 2019

Practice, Part One

I wrote a while back about how online dating got me into meditation.  While I only went on one date with the yoga-loving woman mentioned in the post, we have established a fairly close friendship over the past year, and after listening to her talk about her love of yoga, I decided it was something I should also do.

I had done yoga before, but only in a once- or twice-a-week, go-months-without-practicing kind of way.  Thanks in part to my friend's inspiration, as well as another friend directing me to a fabulous studio, I have now become someone with a regular practice.  I look forward to classes more than almost anything else I do, and I am sad that I don't yet have the stamina to go to a class every day - although I set a personal record of 19 classes in August, so I'm getting there.

In all my posts so far about burnout, I haven't yet written much about the role that yoga played, but ironically, I think it was a big part of why I burnt out when I did.  Before I started doing yoga, I was living with blinders on, getting through each day by focusing on the work and ignoring how miserable it was making me.  In yoga, I spend an hour or more each class inside my own head, and it's really hard to ignore how you're feeling when it's just you and your thoughts*.  Being present with my own emotions forced me to acknowledge them and, eventually, to do something about them.

Yoga also, in a very tangible and physical way, forced me to confront the fact that I am limited.  Doctors aren't supposed to be - we're taught from the beginning of medical school that we should be able to do any amount of work under any conditions without ever making a mistake.  And while I knew intellectually that this was utter nonsense, on an emotional level, this concept of what a physician should be was harder to let go of.  In yoga, my limitations are right there and are impossible to ignore.  If I go to a hard class one day, my muscles will be sore the next day and I won't be able to do the same poses.  I am limited and imperfect.  And I need rest.

Now, on what is hopefully the other side of burnout, yoga is a big part of how I'm rebuilding.  It's exercise and stress relief and a place that always feels safe.  On harder days at work, I take comfort in knowing that I can end my day on my mat, with a bit of calm and a bit of peace.  It's my happy place, and I'm incredibly grateful to have found it.

Namaste.

*and an instructor made of nothing but bone and muscle who can bend their body in super-human ways